Behaviors that cause clinical instructors to question the clinical competence of physical therapist students

Background and Purpose. Clinical instructors (CIs) observe behavior to dete rmine whether students have the skills assumed necessary for safe and effec tive delivery of physical therapy services. Studies have examined assumptio ns about necessary skills, but few studies have identified the types of stu dent behaviors that are "red flags" for CIs. This study examined the studen t behaviors that negatively affect students' clinical performance, which ca n alert CIs to inadequate performance. Subjects. Twenty-eight female and 5 male CIs discussed the performance of 23 female and 17 male students who we re anonymous. Methods. Using questionnaires and semistructured interviews t hat were taped and transcribed, CIs described demographics and incidents of unsafe and ineffective physical therapy. After reading the transcripts, in vestigators identified and classified the behaviors into categories and che cked their classification for reliability (kappa=.60-.75). Results. Behavio rs in 3 categories emerged as red flags for CIs: 1 cognitive category-inade quate knowledge and psychomotor skill (43% of 134 behaviors)-and 2 noncogni tive categories-unprofessional behavior (29.1%) and poor communication (27. 6%). The CIs noticed and valued noncognitive behaviors but addressed cognit ive behaviors more often with students. Students who did not receive feedba ck about their performance were unlikely to change their behavior. The CIs used cognitive behaviors often as reasons to recommend negative outcomes. C onclusion and Discussion. Clinical instructors need to identify unacceptabl e cognitive and noncognitive behaviors as early as possible in clinical exp eriences. Evidence suggests that they should discuss their concerns with st udents and expect students to change.